Application form for shenyang ligong University scholarship

请申请人认真阅读填表说明，用中文或英文填写此表格。Please read the important notes carefully before filling in the form. Please complete the form in Chinese or English.

1. 申请人情况/Personal information：

护照用名/Name in passport：

姓/Family name: _________________________________（BLOCK LETTERS）

名/Given name: __________________________________（BLOCK LETTERS）

国籍/Nationality：________________ 护照号码/Passport No.：________________

出生日期/Date of birth：____________年/Year________月/Month_______日/Day

出生地点/Place of birth：国家/Country：____________城市/City：___________

男/Male□ 女/Female□ 已婚/Married□ 未婚/Single□ 其它/Other□

最后学历/Education level：_____________母语/Native language：_______________

宗教/Religion：___________________

目前所在学校或机构/Place of study or work：_______________________________________________________________

接收录取通知书/奖学金证书地址/Address of receiving acceptance letter or certificate of scholarship：___________________________________________________________________________

电话/Tel： __________________________________ 传真/Fax：________________________________________________

E-mail：手机/Mobile:

永久通信地址/ Permanent Address：_______________________________________________________________________

______________________________________________________________________________________________________

2. 受教育情况/Education background：

学校 在校期间 主修专业 所获证书

Institutions From / to Fields of study Diploma/degree obtained

______________________________ ___________________ ____________________ ____________________

______________________________ ___________________ ____________________ ____________________

______________________________ ___________________ ____________________ ____________________

3. 是否曾在华学习或任职/Have you ever studied or worked in China? 是/Yes □ 否/No □

如选是/If you Choose Yes, please fill in the following. If more, please attach.

自/From________年/Year_________月/Month 至/To：________年/Year_________月/Month

学习或任职单位/ Institution or Employer: _____________________________________________________________

在华学习的经费来源/Financial Support：_____________________________________________________________

自费/Own Expense：□ 奖学金/ Scholarship：□ 其他/ Other Source of Funding： □

4. 语言能力/Language Proficiency:

汉语/Chinese: 很好/Excellent：□ 好/Good：□ 较好/Fair：□ 差/Poor：□ 不会/None：□

HSK 考试等级或其他类型汉语考试成绩/ Level of HSK test or other certificates which can show your

Chinese level:______________________________________________________________________________

英语/English: 很好/Excellent：□ 好/Good：□ 较好/Fair：□ 差/Poor：□ 不会/None：□

我的英语水平可以用英语学习/I can be taught in English: 是/Yes □ 否/No □

其他语言/Other Languages:__________________________________________________________________________

5. 来华学习计划/Proposed Study in China:

是否希望参加教师教育或培训/ Do you want to apply for the teacher education/training program？ 是/Yes □ 否/No □

申请学习时间/Duration of Study: 自/From: 年/year月/month至/to: 年/year月/month

汉语进修生/Chinese Language：： 一学期/one semester □ 一学年/one academic year □

6. 在华事务联系人或机构/Contact of you in China:

名称/Name: _____________________ 电话/Tel: _________________________________________

传真/Fax：______________________ E-mail: __________________________________________

地址/Address: _____________________________________________________________________________

_________________________________________________________________________________________

7. 推荐人/ Referee

推荐人姓名/ Name of Referee: _______________________电话/Tel:________________________________

与申请人关系/ Relationship with Applicant _________________________________________________

推荐意见请另附纸/Recommendations（Please Attach）

申请人保证/ I Hereby Affirm That：

l 本表所填写的内容和提供的材料真实无误；All information and materials given in this form are true and accurate.

l 我保证本人身体健康，符合接收院校相关要求，并于来华后提交有效的《外国人体格检查记录》原件；I promise my health is in good condition and meet the requirements of the acceptance universities and I will submit the original foreigner physical examination form after come to China.

l 在华期间，遵守中国法律、法规，不从事任何危害社会秩序的、与本人来华学习身份不相符合的活动；During my stay in China, I shall abide by the laws and decrees of China, and will not participate in any activities which are deemed to be adverse to the social order and are inappropriate to my capacity as a student.

l 按规定期限离华，不无故在华滞留；I shall return to my home country as soon as I complete my scheduled program in China, and will not extend my stay without valid reasons.

l 到华前，我同意自行购买海外保险。在华期间，奖学金之外所产生费用与在华就读院校无关； I agree to buy Overseas Insurance before entering China. During my stay in China, except the scholarship, all other expenses and losses will not be related to the University which accepted my studying application in China.

l 如违反上述保证而受到中国法律、法规或校纪、校规的惩处，我愿意接受中止或取消奖学金及其他相应处罚；If I am judged by the Chinese laws as having violated any of the above, I will not lodge any appeal against the decision of suspending, or withdrawing my scholarship, or any other penalties.

申请人签字/Signature of the Applicant：____________________________________ 日期/Date：________________

电话/Tel:__________________________________传真/Fax: ______________________________________________

推荐机构负责人签字/Signature of the Referee：________________________________日期/Date：________________